In breast cancer, cells in your breast begin growing abnormally often for unknown reasons. These cells divide more rapidly than healthy cells and may spread through your breast or into other parts of your body. The most common type of breast cancer begins in the ducts designed to carry milk after childbirth, but cancer may also occur in the small sacs that produce milk (lobules) or in other breast tissue.
Breast cancer is the disease many women fear most, though they’re far more likely to die of cardiovascular disease than they are of all forms of cancer combined. Still, breast cancer is second only to lung cancer as a cause of cancer deaths in American women. More than 200,000 American women are diagnosed annually with breast cancer. And nearly 40,000 American women die annually of breast cancer. Breast cancer may be less commonly seen in men, but it is still known to occur.
Yet there’s more reason for optimism about breast cancer than ever before. Great strides have been made in diagnosis and treatment in the last 25 years. In 1975 a diagnosis of breast cancer usually meant radical mastectomy removal of the entire breast along with underarm lymph nodes and skin and muscles underneath the breast.
Today, radical mastectomy is rarely performed. Instead, there are more and better treatment options, and many women are candidates for breast-sparing operations, such as lumpectomy. Emphasis is also being placed on early detection, lifestyle changes, and therapies such as tamoxifen that may reduce the risk of breast cancer.
In addition, a growing network of agencies and resources exists to help those who have just received a diagnosis, are facing treatment decisions or are living with breast cancer.
Knowing the symptoms of breast cancer is critical for early detection and can save lives. Early diagnosis of the disease provides you with a wider range of treatment options and improves the odds of making a full recovery. In fact, when breast cancer is diagnosed and treated in its early stages, the five-year survival rate is 95 percent.
Most breast lumps aren’t cancerous. Yet the most common sign of breast cancer for both men and women is a lump or thickening in the breast. Often, the lump is painless. Other signs of breast cancer include:
A number of factors other than breast cancer can cause your breasts to change in size or feel. In addition to the natural changes that occur during pregnancy and your menstrual cycle, other common noncancerous (benign) breast conditions include:
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Fluid-filled sacs, commonly found in the breasts of women between the ages of 35 and 50, are a frequent occurrence. Cysts can range from very tiny to about the size of an egg. They can increase in size or become tender just before your menstrual period and may disappear completely after it. Postmenopausal women are less prone to cysts compared to other age groups.
These are solid, noncancerous tumors that often occur in women during their reproductive years. A fibroadenoma is a firm, smooth, rubbery lump with a well-defined shape. It will move under your skin when touched and is usually painless.
Breast infections (mastitis) are common in women who are breast-feeding or who recently have stopped breast-feeding, although you can also develop mastitis that’s not related to breastfeeding. Your breast will likely be red, warm, tender, and lumpy, and the lymph nodes under your arm may swell. You also feel slightly ill and have a low-grade fever.
Sometimes a blow to your breast or a bruise also can cause a lump. But this doesn’t mean you’re more likely to get breast cancer.
These tiny deposits of calcium can appear anywhere in your breast and often show up on a mammogram. For the majority of women, there are certain areas with microcalcifications of different sizes. They may be caused by secretions from cells, cellular debris, inflammation, trauma, or prior radiation. They’re not the result of the calcium supplements you take. The majority of calcium deposits are harmless, but a small percentage may be precancerous or cancer. If any appear suspicious, your doctor will likely recommend additional tests.
If you notice any changes in your breast and you haven’t reached menopausal age yet, it’s a good idea to wait until your next menstrual cycle before consulting a doctor. If your symptoms remain for a period of one month, it is important to consult a doctor without further delay.
Early detection is the key to successful treatment of breast cancer – look for signs and symptoms before they become visible to increase chances of finding a cure. Depending on your age and risk factors, screening may include breast self-examination, examination by your nurse or doctor (clinical breast exam), mammograms (mammography), or other tests.
For years, women have been advised to examine their breasts on a monthly basis starting around age 20. The hope was that by becoming proficient at breast self-examination and familiar with the usual appearance and feel of their breasts, women would be able to detect early signs of cancer.
But some studies have shown that teaching women to perform breast self-exams may not accomplish this goal. A large, randomized clinical study in Shanghai, China, for example, concluded that breast self-exams don’t actually reduce the number of deaths from breast cancer. In addition, the study found that women who perform regular breast self-exams may be more likely to undergo unnecessary biopsies after finding breast lumps. This was one of the primary reasons that in May 2003 the American Cancer Society changed its recommendations on breast self-examination, stating that the procedure should be considered an option, rather than a requirement, for most women.
In the newly released guidelines, more emphasis is given to being conscious about breast health rather than mandating monthly self-exams. Although the guidelines don’t say you shouldn’t perform the exams, the importance of self-exams has been replaced by a general need to become more familiar with your breasts. If you’d like to continue performing breast self-exams, ask your doctor to review your technique.
Unless you have a family history of cancer or other factors that place you at high risk, the American Cancer Society recommends having clinical breast exams once every three years until age 40. After that, the American Cancer Society recommends having a yearly clinical exam.
During this exam, your doctor examines your breasts for lumps or other changes. He or she may be able to feel lumps you miss when you examine your own breasts and will also look for enlarged lymph nodes in your armpit (axilla).
Mammograms are the most effective tool for detecting tumors in the breast before they can be physically felt. This imaging technique utilizes X-ray images to detect any irregularities in the breast tissue. Consequently, the American Cancer Society suggests screening mammography for all women above 40 years of age in order to detect potential cases at an early stage.
Yet mammograms aren’t perfect. About 10 percent to 15 percent of breast cancers sometimes even lumps you can feel don’t show up on X-rays (false-negative result). The rate is higher about 25 percent for women in their 40s. Women in their 20s and younger have denser breast tissue, making it harder to identify any irregularities. Thus, mammograms become all the more important for this age group.
In some cases, mammograms may suggest an issue when in reality there is none (false-positive result). This can lead to unnecessary biopsies, fear, and anxiety, as well as increased healthcare costs. The general agreement is that if mammograms have the power to prolong life, all qualified women should be screened for them. That assumption has been challenged in recent years, especially by a 2001 analysis of several large, long-term studies that raised questions about the benefit of mammography screening for breast cancer. The report concluded that several prior studies didn’t clearly show that screening mammograms result in fewer deaths from breast cancer. This led to great confusion about mammography for both women and doctors.
But a study published in April 2003, in which researchers followed more than 200,000 Swedish women for 20 years, hopes to end the confusion. That study found that mammogram screening does indeed reduce breast cancer mortality for women between the ages of 40 and 69 by as much as 28 percent. What’s more, the study’s authors say that mammography screening along with improved treatments can halve the number of deaths from breast cancer.
In 2003, the American Cancer Society released updated guidelines concerning breast cancer screening, strongly advocating the need for women aged 40 or more to have regular mammograms. The American Cancer Society suggests a few additional screening processes which include:
Mammograms require the compression of breasts between two plastic plates to get an accurate X-ray image. The process should be completed in approximately half an hour or less. You may find mammography somewhat uncomfortable. Should you experience any excessive discomfort, be sure to let the technician know right away. To avoid unnecessary discomfort, scheduling a mammogram after your menstrual period is recommended if you have tender breasts. Avoiding caffeine for two days before the test also helps reduce breast tenderness.
Mammography centers are now making mammograms more comfortable by providing a soft foam pad for compression plates, improving the experience for women. The pad doesn’t interfere with the image quality of the mammogram.
Combining your mammogram and physical exam is recommended for maximum efficiency. In this manner, the radiologist is able to carefully analyze any potential anomalies that your physician may have identified. Most importantly, don’t let a lack of health insurance keep you from having regular mammograms. Many state health departments and Planned Parenthood clinics offer low-cost or free screenings. So does the Encore Plus program available through many YWCAs.
In traditional mammography, your X-rays are reviewed by a radiologist, whose skill and experience play a large part in determining the accuracy of the test results. After a radiologist reviews your mammogram, a computer scans it using CAD. CAD identifies more suspicious areas on the mammogram, but many of these areas may later prove to be normal. Still, using mammography and CAD together may increase the cancer detection rate by nearly 20 percent.
This procedure involves the use of electronic technology to acquire and visually display X-ray images on a computer monitor. This allows your radiologist to alter contrast and darkness, making it easier to identify subtle differences in tissue. In addition, the images can be transmitted electronically, so women who live in remote areas can have their mammograms read by an expert who is based elsewhere. Because it’s not yet known whether digital mammography is more accurate or effective than conventional mammography, the procedure is undergoing further investigation.
This technique uses a magnet linked to a computer to take pictures of the interior of your breast. Although not used for routine screening, MRI can reveal tumors that are too small to be detected through physical examination or are difficult to see on conventional mammograms. It’s used at some centers to screen women at high risk of breast cancer as a complementary test to mammograms. MRI isn’t recommended for routine screening because it has a high rate of false-positive results, which can lead to unnecessary anxiety and biopsies.
In this procedure, your doctor inserts a tiny, flexible tube (catheter) into the lining of a duct in your breast the site where most cancers originate, and withdraws a sample of cells. Subsequently, the cells are carefully scrutinized for any precancerous alterations that might eventually result in disease. These changes show up long before tumors can be detected on a mammogram. But because ductal lavage is a new procedure, many unknowns remain, including the rate of false-negative results and whether abnormal cells will necessarily lead to cancer. Clinical trials are underway in an effort to answer the pressing questions that need to be addressed. In the meantime, some doctors are recommending ductal lavage to women who are at high risk of breast cancer either because they have a personal or family history of the disease or because they have a genetic defect that makes them more likely to develop cancer.
Ductal lavage is still considered experimental, so many insurers don’t cover it. If you have an interest in or questions about the procedure, talk to your doctor.
Your medical practitioner may use this approach to investigate any irregularities that appear on a mammogram or felt when doing a physical examination. Ultrasound uses sound waves to form images of structures deep within the body. Because it doesn’t use X-rays, ultrasound is a safe diagnostic tool that can help determine whether an area of concern is a cyst or solid tissue. Breast ultrasound is unsuitable for regular screening due to its high rate of false positives – incorrectly detecting an issue where none exists.
If you, your doctor or a mammogram detects a lump in your breast, you’ll likely have one or more diagnostic procedures to determine if the lump is cancerous, including:
Often, your doctor will suggest a less invasive procedure, such as an ultrasound, before deciding on a biopsy. Ultrasound is a procedure that uses sound waves to create an image of your breast on a computer screen. By investigating this image, your doctor may be able to discern whether the lump is an empty cavity (cyst) or a solid mass. Cysts, which are sacs of fluid, usually aren’t cancerous, although you may want to have a painful cyst drained with a needle.
In some cases, your doctor may want to remove a small sample of tissue (biopsy) for analysis in the laboratory. To do so, he or she may use one of the following procedures:
If a biopsy reveals malignant cells, your doctor will recommend additional tests such as estrogen and progesterone receptors tests on the malignant cells. These tests help determine whether female hormones affect the way cancer grows. If the cancer cells have receptors for estrogen or progesterone or both, your doctor may recommend treatment with a drug such as tamoxifen that prevents estrogen from binding to these sites.
Staging tests are essential for assessing the size and scope of a cancerous tumor, as well as determining if it has spread beyond its original site. Also, they help your doctor determine the most effective treatment for you. A cancer diagnosis is classified into several stages, ranging from 0 to IV. Stage 0 cancers are also called noninvasive or in situ (in one place) cancers.
Although they don’t have the ability to spread to other parts of your body or invade normal breast tissue, it’s important to have them removed because they eventually can become invasive cancers. Finding and treating a cancerous lump at this stage offers the best chance for a full recovery. Stage I to IV cancers are invasive tumors that have the ability to spread to other areas. Stage I cancer is small and well-localized and has a very successful treatment rate. As the stage of the medical condition progresses, the chances of a cure become slimmer. By stage IV, cancer has spread beyond your breast to other organs, such as your bones, lungs, or liver. Although it may not be possible to eliminate cancer at this stage, its spread may be controlled with radiation, chemotherapy, or both.
The discovery of BRCA1, BRCA2, and other genes that may significantly increase breast cancer risk has raised a number of emotional and legal questions about genetic testing. A simple blood test can help identify defective BRCA genes, but it’s only 85 percent accurate, and most experts believe that only those women at high risk of hereditary breast or ovarian cancers should be referred for testing. If you’re one of these women, it’s important to know that having a defective BRCA gene doesn’t mean you’ll get breast cancer. In addition, test results cannot determine how high your risk is, at what age you might develop cancer, how aggressively cancer might progress, or what your risk of death may be.
Testing can help assess the risk of breast cancer, enabling you to make better-informed decisions about reducing your risk and staying healthy. Options range from lifestyle changes, closer screening, and therapy with medications such as tamoxifen to extreme measures such as preventive (prophylactic) bilateral mastectomy or removal of your ovaries (oophorectomy). Making these choices can be extremely difficult for any woman. Talking to a genetic counselor is the best way to make a fully-informed decision about genetic testing, taking into account positives, negatives, and restrictions. It can also help to talk to other women who have had to make similar decisions.
A diagnosis of breast cancer is one of the most difficult experiences you can face. In addition to coping with a life-threatening illness, you must make complex decisions about treatment. Remember, in most cases, no one right treatment exists for breast cancer. Instead, you’ll want to find the approach that’s best for you.
To do that, you’ll need to consider many different factors, including the type and stage of your cancer, your age, risk factors, where you are in your life, the size and shape of your breasts, and your feelings about your body.
Prior to making a decision, it is essential to be familiar with the various treatments that are available so that you can get an informed judgment. Talk extensively with your healthcare team. It’s highly recommended that you seek a second opinion from an experienced breast specialist in a dedicated breast clinic or center. Don’t be afraid to ask questions. In addition, look for breast cancer books, Web sites, and information available from organizations such as the American Cancer Society and the Susan G. Komen Breast Cancer Foundation. Consulting with other women who have had to make similar decisions could help you gain different perspectives and ideas. This may be the most important decision you ever make.
Each stage and type of breast cancer has its own treatment options available now. Most women will have surgery and an additional (adjuvant) therapy such as radiation, chemotherapy, or hormone therapy. Numerous experimental treatments have been made available to a select few or are currently being investigated in clinical trials.
At one time, the only type of breast cancer surgery was radical mastectomy, which removed the entire breast, along with chest muscles beneath the breast and all the lymph nodes under the arm. Today, this operation is rarely performed. Instead, the majority of women are candidates for breast-saving operations, such as lumpectomies. Apart from radical mastectomies, other alternatives such as less aggressive mastectomies and those accompanied by reconstruction are also available.
Breast cancer operations include the following:
Many female mastectomy patients have the option to opt for breast reconstruction after their surgery. When it comes to this decision, there’s no universal answer – it all depends on your individual circumstances. You may find, however, that you have feelings you didn’t expect about your breasts. It is essential to comprehend these emotions before making any decision as this can help you make the right choice.
If you would like reconstruction but aren’t a candidate for the procedure, you’ll need to find a way to come to terms with your disappointment. It may be extremely helpful to talk to other women who have experienced the same situation.
If reconstruction is an option, your surgeon will refer you to a plastic surgeon. The doctor can walk you through the details of the procedure and show pictures of different outcomes for women who have undergone reconstruction. Your options include reconstruction with a synthetic breast implant or reconstruction using your own tissue to rebuild your breast. Mastectomy operations can be carried out immediately or at a later date, depending on your preference.
Radiation therapy is an effective way to cure cancer by using high-energy X-rays to destroy malignant cells and reduce the size of tumors. If you choose lumpectomy, or if a biopsy has confirmed that there are cancer cells in more than four lymph nodes in your armpit, your oncologist will likely recommend radiation to your chest wall after your mastectomy.
Although radiation can be intimidating, it’s worth noting that it has become significantly more accurate and less aggressive than in the past. Radiation is usually started three to four weeks after surgery. You’ll typically receive treatment five days a week for six to seven weeks. The treatments are painless and are similar to getting an X-ray.
Each takes about 30 minutes. The effects are cumulative, however, and you may become tired toward the end of the series. Your breasts may likely appear pink, puffy, and quite sensitive as if they had been sunburnt. Although rare, some long-term and serious complications have been observed in certain cases. These include rib fractures, lung inflammation, injury to the heart, nerve damage, and a change in the appearance and consistency of breast tissue. In extremely rare cases, a new tumor may result from radiation therapy.
Chemotherapy uses drugs to destroy cancer cells. After an operation, your physician may suggest chemotherapy to ensure any cancer cells that may have spread beyond the breast are eradicated. Treatments may involve taking a combination of two or more drugs to help manage the condition. These may be administered intravenously, in pill form, or both. Depending on the circumstances, you can have four to eight sessions between three and six months.
In some cases, your doctor may suggest preoperative chemotherapy taking chemotherapy drugs to shrink a breast tumor before surgery. This may make it possible for you to have a lumpectomy rather than a mastectomy to remove cancer, with the same survival rate as if you were to have chemotherapy after breast surgery.
No matter when it’s administered, chemotherapy can feel like another illness. The side effects may include hair loss, nausea, vomiting, and fatigue. These occur because chemotherapy affects healthy cells, especially fast-growing cells in your digestive tract, hair, and bone marrow as well as cancerous ones. Although not everyone experiences side effects, those who do can now manage them in more effective ways.
Numerous medications are available which can effectively reduce or even eliminate nausea symptoms. Relaxation techniques, including guided imagery, meditation, and deep breathing also may help. Exercise has proved to be an excellent way to combat fatigue caused by chemotherapy treatments.
Hormone therapy is most often used to treat women with advanced (metastatic) breast cancer or as an adjuvant treatment a therapy that seeks to prevent a recurrence of cancer for women diagnosed with early-stage estrogen-receptor-positive cancer. Estrogen-receptor-positive cancer indicates that the presence of estrogen or progesterone in your body might cause the development and growth of breast cancer cells. Normally, estrogen and progesterone bind to certain sites in your breast and in other parts of your body. But during this treatment, a hormonal medication binds to these sites instead and prevents estrogen from reaching them. This may help destroy cancer cells that have spread or reduce the chances that your cancer will recur. Medications that inhibit the impact of estrogen in your system are:
Sometimes called biological response modifier or immunotherapy, this treatment tries to stimulate your body’s immune system to fight cancer.
Using substances produced by the body or similar substances made in a laboratory, biological therapy seeks to enhance your body’s natural defenses against specific diseases. Various new treatments – some of which are still in the experimental stage – are available to be tested during clinical trials. One medication, trastuzumab (Herceptin), is a monoclonal antibody a substance produced in a laboratory by mixing cells that are available for treating certain advanced cases of breast cancer. Herceptin is known to be successful in treating tumors that contain very high levels of HER-2 protein, a condition present in roughly one out of four breast cancer cases.
Scientists are currently exploring various novel therapies for the treatment of cancer. The emphasis is on methods that can successfully treat women or extend their survival with minimal side effects. Among these are drugs that block the biochemical switches that cause normal cells to turn cancerous. In addition, a procedure known as anti-angiogenesis which targets the blood vessels that supply nutrients to cancer cells is also being studied. And gene therapy is an area of ongoing research.
Of particular interest to both women and their doctors are methods of removing breast cancer without actually cutting into or removing the breast. Researchers are investigating new, non-invasive therapies to target and destroy cancer cells deep within the breast with minimal scarring, utilizing either heat or cold. One of the most researched techniques, radiofrequency ablation, uses ultrasound to locate the tumor. Then a metal probe about the size of a toothpick is inserted into the tumor where it creates heat that destroys cancer cells. Initial trials of the procedure have been extremely successful.
Even with the potential of this procedure being available to a large population, only 25 percent of women would be eligible for it. Some of these new treatments are available through clinical trials the standard way new therapies are tested in people. If you have advanced breast cancer and are interested in participating in a clinical trial, talk to your doctor or contact the National Cancer Institute’s Information Service at 800-422-6237 for more information.
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